布比卡因脂质体用于髋关节囊周围神经阻滞对老年髋关节置换术后镇痛的有效性及安全性分析

Efficacy and safety analysis of bupivacaine liposome for pericapsular nerve group block for postoperative analgesia in elderly patients with hip replacement

目的探讨布比卡因脂质体行髋关节囊周围神经阻滞用于老年髋关节置换术后镇痛的有效性和安全性。方法选取2023年5至7月在温州医科大学附属第二医院行全髋关节置换术老年患者42例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,男19例,女23例,年龄(68.8±6.3)岁。按随机数字表法分为布比卡因脂质体组(观察组)和盐酸左布比卡因组(对照组),每组21例,均采用腰麻联合髋关节囊周围神经阻滞的麻醉方法。行髋关节囊周围神经阻滞时,观察组注入布比卡因脂质体10 ml(133 mg)+生理盐水5 ml,对照组注入盐酸左布比卡因10 ml(75 mg)+生理盐水5 ml。主要观察指标为患者术前及术后6、12、24、36、48、60、72 h静止与运动时视觉模拟量表(VAS)评分,镇痛泵中舒芬太尼消耗量、镇痛泵按压次数及病房额外帕瑞昔布钠使用率。次要观察指标为下肢肌力变化、患者住院时间及不良反应发生情况。结果两组患者术前及术后6 h时静息与运动VAS评分差异均无统计学意义(均P>0.05);而在术后12、24、36、48、60、72 h时,观察组患者静息与运动VAS评分均低于对照组(均P<0.05);各组在术后6、12、24、36、48、60、72 h的静息与运动VAS评分均低于术前(均P<0.05)。观察组术后12、24、36、48 h时镇痛泵舒芬太尼消耗量及帕瑞昔布钠用量均低于对照组(均P<0.05),48 h内镇痛泵总按压次数、有效按压次数及无效按压次数均低于对照组(均P<0.05)。所有患者在术后12 h时下肢肌力均能对抗重力活动;术后48 h内观察组恶心发生率为9.5%(2/21),低于对照组的42.9%(9/21,P=0.014);所有患者无术后呕吐发生。观察组住院时间为(9.3±2.2)d,对照组为(8.9±1.9)d,差异无统计学意义(P=0.500)。结论与盐酸左布比卡因相比,布比卡因脂质体用于髋关节囊周围神经阻滞可为老年髋关节置换术患者提供72 h的镇痛效应,减少术后阿片类药物及其他镇痛药物用量,降低术后恶心发生率,对下肢运动影响轻微,且不延长患者住院时间。

Objective To investigate the efficacy and safety of bupivacaine liposome for pericapsular nerve group block(PENGB)for postoperative analgesia in elderly patients with total hip replacement.Methods A total of 42 elderly patients underwent total hip replacement were selected in the Second Affiliated Hospital of Wenzhou Medical University from May to July in 2023,including 19 males and 23 females,aged(68.8±6.3)years,the American Society of Anesthesiologists(ASA)gradeⅠtoⅢ.They were divided into bupivacaine liposome group(observation group)and levobupivacaine hydrochloride group(control group)according to random number table,with 21 cases in each group.All the patients were anesthetized by lumbar anesthesia combined with PENGB.During PENGB,the observation group was injected with 10 ml(133 mg)bupivacaine liposome+5 ml normal saline,and the control group was injected with 10 ml(75 mg)levobupivacaine hydrochloride+5 ml normal saline.The primary outcome measures included the rest and movement visual analogue scale(VAS)scores at 6,12,24,36,48,60,and 72 h after operation,the sufentanil consumption in analgesic pump,the numbers of analgesic pump compressions,and the rates of additional parexib sodium use in ward.The secondary outcome measures were the changes in lower limb muscle strength,the length of hospital stay and the occurrence of adverse reactions.Results There was no significant difference in the rest and movement VAS scores between the two groups at pre-operation and at 6 h after operation(P>0.05);but the rest and movement VAS scores at 12,24,36,48,60 and 72 h after operation in observation group were significantly lower than those in control group(P<0.05);the rest and movement VAS scores at 6,12,24,36,48,60 and 72 h after operation were lower than those at pre-operation in two group(P<0.05).The consumption of sufentanil in analgesic pump and parexib sodium usage in observation group were lower than those in control group at 12,24,36 and 48 h after operation(P<0.05).The total number of analgesic pump compressions,the number of effective compressions and the number of ineffective compressions in 48 h in observation group were lower than those in control group(P<0.05).The muscle strength of the lower limbs of all patients were able to move against gravity at 12 h after operation.The incidence of nausea in 48 h after operation in observation group was 9.5%(2/21),which was lower than 42.9%(9/21)in control group(P=0.014).No postoperative vomiting occurred in all patients.The length of the hospital stay was(9.3±2.2)d in observation group and(8.9±1.9)d in control group,and there was no significant difference between the two groups(P=0.500).Conclusion Compared with levobupivacaine hydrochloride,liposomal bupivacaine in PENGB provides analgesic effects for up to 72 h after total hip replacement in elderly patients,reduces postoperative opioid and other analgesics usage,decreases the incidence of postoperative nausea,and has a minor effect on lower limb movement without prolonging hospitalization.